Comparison of the effects of two low-density lipoprotein cholesterol goals for secondary prevention after acute myocardial infarction in real-world practice: ≥50% reduction from baseline versus <70 mg/dL

Background: The present study compared the effects of two low-density lipoprotein cholesterol (LDL-C) goals for secondary prevention after acute myocardial infarction (AMI) in real-world practice. Methods and results: Of 3091 consecutive patients with AMI who had baseline LDL-C levels ≥70 mg/dL and underwent successful percutaneous coronary intervention, 1305 eligible patients who received discharge statin prescriptions were analyzed. Patients were categorized into 2 groups according to the values of LDL-C at 1 year in two different manners using percent reduction from baseline (≥ 50% reduction, n = 428 versus <50% reduction, n = 877) and fixed levels (<70 mg/dL, n = 625 versus ≥70 mg/dL, n = 680). The primary outcome was defined by the composite of 2-year major cardiac events including cardiac death, non-fatal myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting after hospital discharge. At 2 years, major cardiac events occurred in 139 patients (10.7%). Compared with <50% LDL-C reduction from baseline, patients with ≥50% LDL-C reduction had a 47% risk reduction in major cardiac events (adjusted hazard ratio, 0.53; 95% confidence interval, 0.36 to 0.79; P = 0.002). But, compared with LDL-C levels ≥70 mg/dL at 1 year, patients with LDL-C levels <70 mg/dL at 1 year had a similar risk of major cardiac events (adjusted hazard ratio, 0.96; 95% confidence interval, 0.68 to 1.34; P = 0.793). Conclusions: Obtaining a ≥50% reduction in LDL-C was associated with better clinical outcomes after AMI in real-world practice, whereas achieving a b70 mg/dL was not.